Chest Wall and Diaphragmatic Injuries
Thoracic trauma is the second leading cause of death in case of trauma, after head trauma. Rib fractures are one of the most common injuries affecting trauma patients, occurring in approximately 10% of all cases, and they are associated with a mortality of 3–13%. Frequent complications of this condition are pneumonia, prolonged ventilator time, prolonged hospitalization, and chronic debilitating pain. It has been shown that a greater number of rib fractures are associated with an increased risk of complications, particularly in older patients. Optimal treatment of rib fractures has not been established; in particular, the role of surgery is a matter of debate.
Diaphragmatic injuries have been reported in 0.8–20% of patients hospitalized for blunt trauma and in 3.4–47% of patients sustaining a penetrating thoracoabdominal trauma. Mechanism of injury may be dissipation of energy from the abdominopelvic cavity to the chest in case of blunt trauma or penetrating thoracoabdominal trauma. These result in a laceration of the diaphragm, causing a hernia, that can be diagnosed in the acute setting or remain silent for months or years.
- 1.Pieracci FM, Majercik S, Ali-Osman F, Ang D, Doben A, Edwards JG, French B, Gasparri M, Marasco S, Minshall C, Sarani B, Tisol W, VanBoerum DH, White TW. Consensus statement: surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury. 2017;48(2):307–21.CrossRefGoogle Scholar
- 2.Galvagno SM Jr, Smith CE, Varon AJ, Hasenboehler EA, Sultan S, Shaefer G, To KB, Fox AD, Alley DE, Ditillo M, Joseph BA, Robinson BR, Haut ER. Pain management for blunt thoracic trauma: a joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surg. 2016;81(5):936–51.CrossRefGoogle Scholar
- 4.Olland A, Renaud S, Reeb J, Guinard S, Jeitlinger J, Santelmo N, Falcoz PE, Massard G. Traitement chirurgical des traumatismes fermes du thorax et technique de l’osteosynthese costale. Encyclopedie Medico Chirurgicale, Techniques chirurgicales Thorax. 10.1016/S1241-8226(16)64626-1.Google Scholar
- 5.Kucharczuk JC, Cohen JE. Thoracic Trauma, Chapter 100. In Intensive Care Unit Manual, pp. 916–20.Google Scholar
- 6.Bailitz J, Hedayati T. Thoracic trauma. Emerg Med. 78:681–94.Google Scholar
- 7.Asensio JA, Trunkey DD. Thoracic injuries. In: Asensio JA, Trunkey DD, editors. Current therapy of trauma and surgical critical care. 2nd ed. New York: Elsevier; 2016. p. 205–28.Google Scholar
- 12.Zaw AA, Murry J, Hoang D, Chen K, Louy C, Bloom MB, Melo N, Alban RF, Margulies DR, Ley EJ. Epidural analgesia after rib fractures. Am J Surg. 2015;81(10):950–4.Google Scholar
- 15.Kerwin AJ, Haut ER, Burns JB, Como JJ, Haider A, Stassen N, Dahm P, Eastern Association for the Surgery of Trauma Practice Management Guidelines Ad Hoc Committee. The Eastern Association of the Surgery of Trauma approach to practice management guideline development using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S283–7.CrossRefGoogle Scholar
- 21.Steyn E. Penetrating injuries to the diaphragm. In: Velmahos GC, Degiannis E, Doll D, editors. Penetrating trauma. Berlin: Springer; 2017.Google Scholar
- 23.Dante Yeh D, Lee J. Trauma and blast injuries. In: Robert Mason V, Broaddus C, Martin T, et al., editors. Murray and Nadel’s Textbook of respiratory medicine. 5th ed. Philadelphia: Saunders. p. 1354–66.Google Scholar
- 26.Groth AS, Andrade RS. Thoracic surgery clinics. Diaphragmatic Eventration. 2009;19(4):511–9.Google Scholar